The stigma related to opioid prescribing has painful consequences for patients

Carolyn Concia, NP, faced greater consequences for restricting opioid prescribing when she learned why her friend’s son died by suicide.

The son was unable to sleep because he was in severe, chronic pain from injuries sustained during his military service in Afghanistan and sought medical help. The doctor thought he was in search of drugs and didn’t prescribe anything to alleviate his symptoms, so the distraught young man returned home and ended his life. At first, Concia thought this case was out of the norm, but she soon discovered that other people across the country were combating similar problems. People with chronic pain who had been taking opioids responsibly for years were suddenly forced to cut back or discontinue their medications. Others who desired to proceed prescribing opioids had difficulty finding providers who would accept them as latest patients. “These people are suffering from withdrawal symptoms as well as increasing pain because they are no longer receiving appropriate treatment,” said Concia, a nurse practitioner in a non-public geriatric and palliative care practice in Oregon. “Patients are confused, scared, and many have lost the ability to function.” Concia isn’t alone in her concern for patients suffering each physically and mentally as insurance firms, healthcare providers and government organizations change opioid prescribing policies.

The opioid prescription paradox

2019 test primary care clinics in Michigan found that 40% of clinics wouldn’t accept latest patients receiving opioid therapy for pain. In a study published in Pain management nursingresearchers conducted interviews and surveys to know the experiences of painkiller seekers who had been taking opioids for six months or longer, and the outcomes were sobering. “We found that many of these patients felt like they were fighting against a health care system that was supposed to provide help,” said study writer Crystal Lederhos Smith, Ph.D., assistant professor within the College of Medicine at Washington State University. “Not only did they suffer from chronic pain, but they also felt demoralized because they were labeled drug seekers and bad people.” The policy changes also affect patients in hospitals who experience acute pain, said Maureen Cooney, DNP, FNP-BC, a nurse practitioner specializing in pain management at Westchester Medical Center in Valhalla, New York. Many states have passed laws limiting the prescribing of opioids for the treatment of acute pain within the hospital until discharge. Some of those laws limit patients who’ve never taken opioids to a seven-day supply of those drugs. As a result, patients needing refills must contact their surgeon or primary care physician.

“Getting an appointment isn’t always easy, and many doctors don’t feel comfortable prescribing opioids,” Cooney said. “This can leave people struggling with pain after they are discharged from the hospital.”

She also began to note a rise within the variety of patients who refused to take opioids because they feared they might develop opioid use disorder. Cooney often recommends multimodal analgesia, which mixes pain medications from two or more drug classes, to treat pain. For example, patients with rib fractures may profit from opioids when used together with nonopioid analgesics and when the danger of developing opioid use disorder is assessed. “Opioids, along with nonopioid medications and nonpharmacologic approaches, may be appropriate when pain is severe and uncontrolled pain is a problem in recovery,” said Cooney, president-elect of the American Society of Pain Management Nurses (ASPMN). . “If patients are in too much pain to be able to breathe, cough, and move well, they increase their risk of pneumonia and other complications.”

Uncovering misconceptions about prescription opioids

Although pain management nurses agree that the country is facing an opioid epidemic, researchers corresponding to Dr. Cathy Carlson, APRN, FNP-BC, have been concerned that the statistics don’t accurately represent the issue. Carlson, an associate professor at Northern Illinois University School of Nursing, began studying the methods used to calculate statistics corresponding to the variety of deaths involving prescription opioids, and discovered that many individuals dying from overdoses had multiple substance of their system. “They may have died from a drug other than the prescribed opioid, but it’s still labeled as a death from a prescription opioid,” said Carlson, whose Results were recently published within the journal Pain Management Nursing.

Carlson also investigated the claim that overdose deaths from prescription opioids are on the rise and account for the vast majority of opioid-related deaths. She found that illicit opioids are the first reason for the present increase in opioid overdose deaths, while prescription opioid overdose deaths declined after 2011, with a slight increase since 2014.

While nurses like Carlson support policies that encourage providers to exercise caution when prescribing opioids, they’re concerned about guidelines that limit the flexibility to individualize treatment. CDC Guidelines for prescribing opioids for the treatment of chronic painin 2016, it urged providers to not prescribe greater than 90 milligram morphine equivalents (MME) per day. This limit was much lower than required within the case of a 64-year-old woman who turned to Concia for help. The woman had suffered complications from multiple surgeries to treat colon cancer, and her doctor had prescribed her opioids for several years for chronic abdominal pain. “She was an exemplary patient,” Concia said. “She never negotiated for more medications, never shopped at the doctor, and always used one pharmacy.”

Four years ago, her doctor suddenly stopped prescribing opioids, and since then, many doctors have refused to make use of her because she suffered from chronic pain. Her pain became so severe that she stopped working, rarely left her room, and lost her ability to operate.

Concia fastidiously evaluated the case and decided to prescribe a mixture of oxycodone and morphine. Concia provided the girl with an authorized letter stating that her patient was eligible to make use of opioid pain medications to oversee her symptoms and that she was not liable to diversion, addiction, misuse or abuse. This letter might be forwarded to your pharmacist if vital. After beginning to take the drug, the girl’s pain decreased significantly and she or he returned to her each day activities.

Opioid regulations affecting children

Reducing opioid prescribing also impacts the pediatric patient population, said Sharon Wrona, DNP, PNP, FAAN, director of comprehensive pain management and palliative care services at Nationwide Children’s Hospital in Ohio. She sees patients who profit from opioids after they have pain from sickle cell disease, arthritis, muscular dystrophy or serious accidents, but families are sometimes afraid to inform others locally about their use of those medications, Wrona said.

“They also fear they won’t be able to get their prescriptions filled because pharmacies and insurance companies vary in what they allow,” she said.

In Ohio, pediatric patients can leave the hospital with a five-day prescription for opioids used to treat acute pain, but exceptions are allowed if a physician deems it vital. Wrona wrote an prolonged prescription – with an evidence of why it was vital – for a patient who had suffered multiple fractures in a automobile accident, but his pharmacy was not willing to fill the prolonged prescription. To help educate federal and state organizations in regards to the implications of recent prescribing regulations, Wrona, who can be immediate past president of ASPMN, testified on the 2018 public hearing of the FDA’s Opioid Policy Steering Committee. She discussed the importance of individualized pain management, which incorporates greater insurance coverage for opioids, in addition to other types of pain treatment corresponding to acupuncture and non-opioid painkillers. While it might be tempting to denigrate policymakers who create stricter opioid prescribing regulations, Dr. Marsha Stanton, a pain management nurse advocate, believes that a lot of these leaders may not understand the implications of the brand new rules. “It’s a matter of educating them about what led to the crisis and how we went to the other extreme,” said Dr. Marsha Stanton, RN, an ASPMN member who advocates for more individualized opioid prescribing policies. “Generally speaking, they are quite open and want to hear how it all went wrong.”

Take these courses on opioids and pain management:

The purpose of this continuing education program is to offer nurses with information on best practices in prescribing controlled substances, including the secure and effective prescribing, administration, and allotting of controlled substances to a patient with chronic pain. This continuing education module examines the characteristics of heroin, corresponding to its appearance, chemical structure, approach to administration, metabolism, and mechanism of motion, to elucidate how the drug produces such a robust, unique euphoric effect in comparison with other opioid drugs. This includes identifying and treating heroin overdose, withdrawal, addiction, and other complications related to chronic use. This continuing education module incorporates a public health approach across your complete spectrum of pain management, which might be achieved without worsening the opioid crisis. The strategy begins with stopping and effectively treating acute pain while avoiding unnecessary exposure to opioids, followed by early identification and effective treatment of chronic pain or opioid use disorder, after which stopping morbidity and mortality from “high-impact chronic pain.” “.